To Hell and Back
by csi101
Summary: Set after the events of Lost Son - however, in this version, Speed survives and is recovering in hospital. It is set out as clinical notes written by the psychologist sent in to counsel Speed when he is diagnosed as suffering from Post Traumatic Stress Disorder (PTSD). As a result, it is not written as a traditional story but more as dictated notes from the counselling sessions.
1. Chapter 1

Tuesday, October 12, 2004

First consultation today with Mr Timothy James Speedle (preferred name: 'Tim').

Tim is a 31 year old male currently employed by Miami-Dade police department as a criminalist. Referred while an inpatient at Ryder Trauma Centre post gun shot wound to chest. Patient shows early symptoms of PTSD with insomnia, nightmares and generalized anxiety. Currently 22 days post admission.

Consulting physicians: Mr Jim Martin (trauma surgeon) and Dr Ridi Radinajah, (general medical).

Introductory visit with Tim today. A quiet and reserved man, he appeared reticent to contribute much to our discussion. Continuing to experience some pain and discomfort across left chest and shoulder - could be impacting general demeanor of patient. Due for discharge next week. States has 'never been in therapy' in the past and 'unsure as to what to talk about'. Conversation today centered on events of previous 2 weeks. Tim's memory of said events very limited.

Past medical history - No diagnoses of previous mental health issues. No history of illicit drug use. Social smoker/drinker. Tonsillectomy age 12 years. Motorcycle accident 2000 - fractured 2 ribs and dislocated shoulder.

Facts: 

Medical -

Tim attended MacCauley Jewelers, SW 42nd Ave, Coconut Grove at approx. 1520 with his supervisor, Lieutenant Horatio Caine. Gun shots were exchanged between police and 3 assailants within the jewelry store which resulted in Tim receiving life threatening injuries. The bullet entered through the left intercostal space (4-5) and shattered on entry causing extensive damage to the upper lobe of his left lung and a partial tear to his pulmonary vein. Tim was airlifted to Ryder and underwent immediate emergency surgery to remove a portion of his upper left lobe and suturing of his pulmonary vein. There was significant blood loss requiring 15 units of packed cells in total and resulting in cardiac arrest on two separate occasions - each time successful resuscitation with a combination of CPR and cardioversion. Post surgery, Tim spent 3 days in an induced coma in ICU before sedation was weaned and he regained consciousness. He has unreliable memories of familiar voices during this time. He spent a total of 11 days in the intensive care unit before being transferred to General Ward 5A. Intercostal catheters were removed day 6. Morphine infusion weaned day 7. Pain currently managed with combination of codeine plus paracetamol and occasional pethidine. Physical therapy commenced during ICU stay and continued on ward.

Family - Very limited familial support. Tim has been estranged from parents and younger brother for past 12 years. Patient reluctant to discuss details of estrangement during today's session and anxiety levels noticeably increased when subject of family arose. States he has friends in Miami who 'are his family now'. On further questioning, nominates colleague Dr Alexx Woods and her husband, Dr Joe Woods, as close friends and it is apparent he regards them as pseudo parents. He displays genuine affection when talking about their influence on him and it is clear they are a constant presence in his personal life. Both have been frequent visitors throughout his hospital admission. On general discussion, it appears Tim has also assigned a pseudo parental role to his supervisor, Lieutenant Caine. The manner in which he describes their relationship makes it very clear he holds Lt Caine's advice in high stead and relies on his guidance and support heavily. Lt Caine has also had a strong presence at the hospital during the past 3 weeks. On further questioning about his 'Miami family', Tim became visibly uncomfortable and requested the topic be changed. To follow up on this in future sessions.

General - Tim has clear memories of the moments prior to the shooting taking place and limited memories from the moment of being shot through to waking in the intensive care unit. He states his last memories were walking into the jewelry store and looking through a glass partition wall into the rear of the store. On further questioning, he has vague 'snippets' of being on the floor and not being able move and a 'white heat' which radiated from his chest through his entire left side. He has some vague memories of familiar voices and states he 'could hear them talking but couldn't open [his] eyes'. He states he believes in hindsight that the voices belonged to his friends Drs Alexx and Joe Woods. He has memories of waking in the intensive care unit, however on further discussion, it appears these memories may have been from at least 24 hours post regaining consciousness. Tim states he has been having 'some trouble' sleeping lately and wakes several times during the night. He doesn't remember having specific nightmares but states he often feels 'panicked' when he first wakes. Nursing staff have confirmed he has often been unsettled during sleep and wakes in cold sweats and often emotional. Nursing staff also confirm he has requested Dr Alexx Woods be contacted on two separate occasions and she has been required to come to the hospital to settle him when his anxiety has not abated quickly. Tim states that he is very keen to go home and believes he will be able to manage independently on discharge.

Plan: Commenced on sertraline 25mg daily and review in 4 weeks. Alprazolam 0.25-0.5mg daily prn for acute anxiety episode and for insomnia if required. Highlighted addictive qualities and reinforced need for compliance. Arranged follow up appointment for Friday.


	2. Chapter 2

**The second chapter is set out in the same way as the first - written as psychologist notes during a counselling session. Please take a minute to leave some feedback at the end - it is very much appreciated and gives me an indication as to if I should keep going with this story. Thanks.**

Friday, October 15, 2004

Second consultation with Timothy Speedle.

Tim tired and reserved again today. Remains quietly spoken and appears naturally introverted. Managing well to date on sertraline however states has been feeling 'a bit weird' and likens it to being almost in a dreamlike state and feeling nauseated at times. Reassured both common side effects of SSRI treatment and will subside. States continuing to struggle with poor sleeping but has been reticent to try alprazolam to date as feels it will resolve by itself. Reminded of importance of good sleeping habits when combating PTSD and encouraged to trial same while in hospital.

Continues to have limited interest in talking about himself. Remains difficult to draw into conversations. Focused on his family today. Again, Tim visibly uncomfortable with this topic. Forced the issue and, under sufferance, Tim opened up about his childhood.

Childhood:

Parents - Margaret and Peter Speedle

1 sibling - Matthew, 13 years Tim's junior.

Parents married approx. 33 years.

Father - owns 3 restaurants (2 in Queens, NY and 1 in Syracuse, NY).

Mother - social worker.

Tim speaks in an almost detached manner when the topic of his parents is raised. Very little emotion and displaying subconscious physical responses (arm scratching and tapping of fingers against his knee) when reciting family history.

Tim states his family lived in comfortable neighborhood in Queens, NY. States family home was 'upper middle class' and his parents financial status allowed them to send their children to 'good schools'.

States did not have a traditionally close relationship with either of his parents. According to Tim, his father was often absent managing his restaurants - long hours and and regular trips to Syracuse - and appeared emotionally disinterested in his son when he was physically present. His mother worked full time as a social worker for the Department of Social Services in Queens, NY dealing with abused and neglected children. Tim states his mother was passionate about her job and would often work after-hours and on weekends in addition to volunteering for community programs until he turned 13. Up until this time, Tim had been an only child. Three weeks before his 13th birthday, his mother gave birth to his younger brother, Matthew. Tim describes natural feelings of ambivalence and slight resentment towards his younger brother and states he always felt that he had 'little in common' with Matthew due to the significant age gap.

Tim talks about desire for rebellion against his parents when in his teenage years. Although he continued to excel with his grades, he speaks about experimenting with cigarettes and alcohol from age 13 and truancy from school - primarily to annoy his parents. Tim is able to reason that his behavior was likely a combination of normal teenage desire for independence from his parents in addition to the arrival of his younger brother into the family unit.

Tim describes feelings of loneliness and social isolation as a young child. Unable to name more than 3 close friends from age 5-12. Attended St Marks private elementary school in Queens. Tim states he 'hated' elementary school as 'didn't fit in' and describes classic indicators of poor social skills and introversion - not wanting to socialize with peers out of school hours, feelings of stress when forced to socialize.

States enjoyed reading and found solace from school by going to library and reading during breaks in class. States always felt 'safe' when he was by himself reading.

Attended John E. Morrow High School, Queens, NY. States similar to Elementary and Middle school - describes few friends and naturally independent. Despite feelings of social isolation, however, Tim admits he did date 'on and off' throughout high school and into college, but no one serious girlfriend before arriving in St Petersburg as a 20 year old.

Reluctantly talked about having one best friend from age 14 (Ben). Both boys shared similar interests, particularly science. Tim talked about experiencing family holidays in Florida with Ben's family and associated good memories with St Petersburg in particular. Tim states he had never had holidays up to that point and felt, for the first time, that he was part of a functional family.

The boys remained friends up until Ben's death at age 19 from complications post a snow mobile accident 18 months earlier - witnessed by Tim. Ben had apparently suffered severe spinal injuries resulting in full quadriplegia.

A marked increase in agitation and anxiety levels was apparent as the conversation continued regarding Ben and it was clear that Tim has spend the intervening years successfully developing certain defense mechanisms to cope with his friends paralysis and subsequent death. There are elements of both repression and suppression. There are certain specific memories of the accident itself that he is unable to recall and large periods of time that are unaccounted for. It is my opinion that Tim has repressed certain particularly upsetting memories of the accident and the arrival of Ben's family and of his own family. When questioned about specifics, he stated he 'doesn't know' why he does not have memories of the immediate aftermath of the accident when he has very clear memories leading up to the accident and once they had arrived at the hospital. His agitation levels increased markedly when pushed to concentrate and to try to remember the details. It is my opinion that Tim has buried the memories too deeply to access spontaneously.

Tim became emotional when remembering the events leading up to his friend's death. When questioned further, it became clear that Tim harbors deep seated guilt that his friend was gravely injured and endured major suffering up until his death when it could have 'just as easily been [him]'.

Conversation switched to his family dynamic in relation to the accident. Tim states he could not remember what his parents reactions were when they arrived at the hospital. He states he cannot remember their reaction to his obvious distress during the time of Ben's hospitalization and only remembers their insistent that he continue on to college as planned. Tim states he did not feel comfortable in discussing his feelings about his friends accident to his parents nor does he remember ever talking with them about changing his preference from medicine to biology and chemistry majors. He expressed his rationale for changing his preference in terms of wanting to 'do something constructive to help Ben and to cure him'. He also spoke about his feelings of despondency and failure when Ben died and he realized 'it was all for nothing'. Despite encouraging Tim to explore this statement in more depth, he became emotional once again and asked for the session to end.

Based on Tim's interest in reading and drive for understanding, I have devised a plan of treatment including psychological journal articles so he can better understand how his mind has compartmentalized his memories as a mode of self preservation.

PLAN: Continue sertraline treatment as prescribed in first consultation.

To trial alprazolam while still an inpatient to re-establish good sleeping patterns.

To follow up with counseling session Monday prior to discharge.


	3. Chapter 3

Monday, October 18, 2004

Third consultation with Timothy Speedle.

A setback for Tim over the weekend. Became febrile (101.9°) on Saturday morning with increased shortness of breath and decreased oxygen saturation. Chest x-rays show some consolidation in left lobe of lung indicative of lower respiratory chest infection. Commenced on intravenous co-amoxiclav 500mg/100mg qid. As a result, discharge date has been delayed until at least Thursday.

Tim very despondent with setback. States 'just wanted to go home' and obviously very frustrated with having to stay in hospital.

States 'not feeling like talking' today. Reinforced the importance of working through the process of cataloging experiences in order to effectively move forward. Tim clearly dubious about the benefits of counseling sessions and refusing to open up. An air of radiating hostility is present today.

Several attempted openings for discussion all rebuffed by Tim with agitation and irritation levels both increasing the more the discussion was pushed.

Session ended early and, instead, obtained reluctant permission from Tim to contact both Dr Alexx Woods and Lieutenant Horatio Caine to discuss their responses to his shooting. Reinforced patient confidentiality strictly adhered to and everything discussed in our sessions will remain private.

PLAN: Follow up tomorrow and attempt to initiate discussion on his friend's death.


	4. Chapter 4

Monday, October 18, 2004

ADDITION TO NOTES FOR MR TIMOTHY JAMES SPEEDLE

After aborted consultation this morning, telephone contact established with Dr Alexx Woods.

Dr Woods voiced obvious concern regarding Tim's welfare.

Opened the discussion by asking about her relationship with Tim and how they had first met. Dr Woods described how she had been employed in her current role as Miami-Dade county coroner when Tim first joined the C.S.I. team from St Petersburg. States she had offered him a 'home cooked meal' as he had not known anyone in Miami initially.

According to Dr Woods, Tim had discussed his plans to major in neurology at college and how his initial goal had been to get involved in the area of spinal damage research. She states the topic of conversation had interested both herself and her husband due to their background in medicine.

Dr Woods states that, over time, both she and her husband developed a strong relationship with Tim and had offered him a stable family environment. She states that they had become trusted confidantes of Tim's and were aware of his dysfunctional childhood which had solidified their desire to provide him with a reliable and loving environment.

Married for over 15 years and with two young children, Dr Woods states Tim has been a regular dinner guest in their family home and has been involved with tutoring their son in math.

She states he has formed strong friendships over the years he has been living in Miami both inside and outside of the crime lab.

Currently single, he has maintained normal and healthy relationships in the past. Dr Woods states, however, that these relationships are often short lived (weeks to months) and that she often worries about Tim due to his highly sensitive nature. She states that he is prone to falling in love quickly and being left 'with a broken heart' when the relationships fail. She states she worries that he tends to choose women who 'use him up then discard him' and that she feels it has negative effects on an already sub par ego.

When questioned further, Dr Woods states that Tim tends to withdraw into himself to deal with broken relationships and has been known to 'disappear' for several days at a time on his motorcycle.

When asked about communication, Dr Woods states that Tim initially would hide his feelings from everyone but, over the course of the past few years, has become more comfortable sharing personal conversations with her.

She states that her husband also maintains a strong friendship with Tim and the two of them have taken motorcycling and fishing trips together. Dr Woods states that her husband had become a father figure to Tim and someone who he feels he can trust and 'lower his guard' with.

Dr Woods states that both she and her husband consider Tim as an extended member of their family and are both deeply concerned about his welfare. They are both willing to be active participants in his care, both physically and psychologically, post hospitalization and state they have already put plans into place to support him on discharge.

Based on the information provided by Dr Alexx Woods, I am confidant that, despite having no support from biological parents, Tim will have solid, dependable and ongoing psychological support from two people who obviously care for him very deeply.

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	5. Chapter 5

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Tuesday, October 19, 2004

ADDITION TO NOTES FOR MR TIMOTHY JAMES SPEEDLE

Appointment attended this morning by Lieutenant Horatio Caine.

At first, Lt. Caine appeared reticent to open up. There was an unspoken discomfort when the discussion turned from pleasantries to personal details about his relationship with Tim. I reinforced the confidential nature of this discussion and the importance of understanding Tim's history and personality prior to the shooting in order to effectively help him progress in the future.

Lt. Caine visibly relaxed and became much more open and forthcoming with our conversation.

Lt. Caine states he met Tim initially when he transferred from St Petersburg police department (where he worked as a uniformed officer) to Miami-Dade criminalistics department as an entry level crime scene officer in Lieutenant Caine's team. With his strong science background, Lt. Caine was instrumental in encouraging Tim to return to New York to complete his Masters Degree in Chemistry before offering him a permanent job in the crime unit.

Identifying Tim as a quiet but, at times, impulsive young man, Lt Caine states he recognized certain traits which he had in common and tried to tailor his teaching style to suit Tim's often reserved personality. Lt Caine went on to state that Tim has a very high level of intelligence and enjoys reading non fiction books to fuel an almost insatiable desire to learn. He is aware of Tim's fractured relationship with his biological family and states that because of this he feels a certain level of responsibility to Tim with regard to mentoring him on life skills as well as work.

Lt. Caine went on to describe the circumstances of his own childhood, which shall remain off record however certainly explain why there is a parental protectiveness which he has towards Tim. He spoke about the differences in mentoring his three CSI's and how each one was treated individually - to quote,

_'...with Calleigh, it's simply a matter of support. She is _

_a talented investigator who has been in the field long_

_enough to be completely autonomous. Eric needs the_

_most mentoring in terms of case management. He is the least _

_experienced of the team but has keen observational skills_

_and just needs a guiding hand when working a case through_

_from start to finish. Speed...Speed is the classic 'middle_

_child'. He is a very talented criminalist and can certainly _

_manage a scene independently, but I feel any deficits he _

_has is simply related to undisciplined focus of attention and _

_a lack of self confidence and self awareness. He _

_has an enormous amount of potential but can be almost _

_sloppy in his attitude some times and he requires more of a firmer _

_hand management wise. With Speed, I almost feel that _

_I'm having to be a combination of boss and father and I feel _

_a responsibility to support him in ways that are not necessary _

_with the others. Of all of my team, Speed is the one who _

_challenges me the most and concerns me the most - I see a lot of myself in him. _

_He is the one __who needs the most 'parenting'. He needs a family.'_

In response to Lt. Caine's statements about his colleague, the topic was shifted to his own emotions regarding Tim's shooting and subsequent hospital admission.

Lt. Caine states that, in the initial moments after the shooting, his primary focus was on keeping Tim alive until medical aid arrived. After the arrival of the paramedics, he described feeling almost physically unwell and very shaken. Giving a very clinical account of the events, he described feeling the tackiness of his partners blood on his hands and its cold wetness as it soaked into his shirt. He states he has little memory of actually driving to the hospital however can recall very clearly the 'frustrating' number of hours spent in the hospital with Dr Alexx Woods and Eric Delko as they waited for news and how he felt waves of anger and hostility towards the police departments IAB representative who was 'insisting on our statements' and the crushing feelings of helplessness with regard to knowing there was nothing they could do for Tim.

Lt Caine described how the past 3 weeks have affected him personally. He states he feels the pressure of parental responsibility to Tim, particularly with the absence of his biological parents. He describes feelings of great protectiveness towards all of his team but particularly for Tim at the moment. He also expresses frustration and a sense of disbelief that, despite being contacted, Tim's parents remain estranged from their son when he needs them the most.

He states he has been juggling work and hospital visits and has been actively planning for Tim's discharge in conjunction with the Woods' family and the hospital.

On a personal note, he describes very strong feelings of guilt. When questioned further, he states he realizes logically that there was nothing he could have done to prevent the shooting, however finds his mind is regularly replaying the events and states he wakes usually at least once per night with vivid dreams where he is watching the shooting take place but from Tim's point of view.

I have reinforced to Lieutenant Caine the reality that he is not responsible for the shooting having taken place and is, instead, responsible for saving Tim's life. I have validated that the feelings of guilt are normal and natural responses and I have encouraged him strongly to persue ongoing psychological counselling sessions in order to process and recover from both the trauma of Tim's shooting and the residual psychological scars from his childhood.

I am happy to continue ongoing contact and support for Lt. Caine throughout the remainder of Tim's care.


	6. Chapter 6

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Tuesday, October 19, 2004

Fourth consultation with Timothy Speedle.

After yesterday's aborted session, contact made again this afternoon for general review and consultation.

Tim continuing on intravenous antibiotics but states starting to feel 'better'. Fevers have abated and oxygen requirements have reduced to 2 l/min via nasal cannula prn. Continuing to hope for discharge home Thursday, 21st October.

Tim apologized for canceling our session on Monday and states he was not feeling well. States also that he has spoken with Dr Alexx Woods and is 'on orders to behave' - humor evident which is encouraging to see.

Talked about his obvious dislike of psychological counseling and asked him why he feels this way despite an extensive interest in neurological health. Tim states he has never really paid much credence to psychology and always tended to focus on 'hard science'. States he can remember when he was younger and a cousin was diagnosed with depression. He remembers his parents insinuating regularly that she was simply 'an attention seeker' and how they had never regarded mental health issues as legitimate. Suspects his attitudes reflect his parents bias against mental health legitimacy.

Reinforced that it is OK for him to harbor suspicions about the benefits of counseling, however have asked for compliance in completing planned session and to treat these sessions as a clinical trial - to wait until the end and then review success or failure based on results. Agreement made with a smile and a handshake. Tim appears much more relaxed and open to communicating today.

Tim noticeably tensed up when the conversation moved back to his friends accident and subsequent death. Becoming very quiet, it took several minutes for him to participate in the conversation again.

When asked to describe what he could remember from the day of the accident, Tim dropped his head down and spoke very quietly.

Tim described how the accident happened 3 days into a week long vacation to Ben's grandparents in Up State New York and, quote:

_'...Ben and I had driven up with another couple of Ben's cousins. We_

_were supposed to be up there for 10 days during the mid term break. It _

_was supposed to have been a snowboarding trip but we had gotten hold _

_of a couple of snowmobiles from a hire place. We'd been out most of _

_the morning and had started playing this stupid game we'd come up with - _

_which was kind of like football on snowmobiles. It was such a stupid game - _

_and the thing is, we weren't even interested in normal football. We hated the _

_game! Yet for some insane reason, we just started tossing this soda bottle_

_we'd found around and racing each other to set ends. When we got bored _

_with that, we took off racing in between trees and around this forested area. _

_It was hillier than it looked and we were going pretty fast and just being dumb,_

_y'know. I was chasing Ben down this slope and he disappeared around this _

_big tree, and then I heard this grating sound and as I came around the _

_corner I saw his snowmobile over on its side - still idle-ing - and I couldn't _

_see Ben straight away. I looked around and saw him lying about 8 or 9 feet from where his vehicle was. There was a log barely visible under a drift of snow and_

_he's hit it before he'd had time to stop and had been thrown over the handlebars. He'd landed on a rock and it had broken a couple of his vertebrae. He was just lying there. I got help and we got him to hospital. He'd broken his neck and part of the bone had severed his spinal chord. He was paralyzed from the neck down. They airlifted him back to New York and he spent the next 19 months in hospital and rehab before his final round of surgery. He'd beaten the odds so many times before that we all just thought he'd pull through again. When he didn't...we all struggled to cope with it.'_

Tim was able to talk through the entire experience very clinically with little emotion evident in his voice - however the subconscious tapping of his hand against his knee was noted once again. There were many similarities noted between Tim and Lt. Caines with regard to their delivery of remembered event and body language.

With regard to the retelling of events, I asked Tim to think back to the specific moment that he found Ben after the accident and the intervening minutes until he went for help.

Tim's body language changed almost immediately as the defense mechanisms were instantly engaged - arms folded, eyes fixed on the floor and a clear physical discomfort. When he finally spoke, he stated that he could not remember what happened during that time. When asked what his final memory was before help arrived, he closed his eyes, reopened them after several moments, and stated that it was so long ago he was having difficulty distinguishing what were real memories and what was the result of nightmares since the event. When asked to focus on the memory of seeing Ben lying in the snow as he came around the side of the tree on his snowmobile, Tim became noticeably tense. Again, he stated that he could not remember specific details.

I am confidant that Tim is suffering from repression of memories and has genuinely no memory of the minutes in-between the accident and summoning help.

I have recommended a single starting hypnosis session with the option of follow ups if necessary. Tim hesitant to try and states does not understand what 'reopening old wounds' will achieve. Talked through the suspicions that the PTSD could stem from the events of the death of his friend, and exacerbated by his own near death experience from the shooting. It was reinforced that uncovering the traumatic memories from that time will enable us to process the recent events and move forward.

Tim remains hesitant, however agreed to try hypnosis session and stated 'will try anything if it helps him to sleep'. States had tried alprazolam 0.25mg last night and continued to sleep poorly. Reinforced not to expect results immediately and suggested continuing with an increased dose of 0.5mg alprazolam tonight. Educated on simple relaxation techniques to assist with settling.

PLAN: Continue alprazolam 0.5mg nightly prn

Continue sertraline 25mg

Follow up on relaxation techniques

Schedule initial hypnotherapy session tomorrow (Wed) October 20


	7. Chapter 7

**Another chapter - I hope you enjoy reading it and, as always, any feedback would be greatly appreciated...**

Wednesday, October 20, 2004

Fifth consultation with Timothy Speedle - Initial hypnotherapy session.

Tim improving medically. Has remained afebrile over previous 24 hours with intravenous antibiotic treatment continuing. Aim for switch to oral antibiotics tomorrow and potential discharge home with support. Pain being well managed with paracetamol and occasional codeine.

Tim states he had a better night sleep last night and feeling rested today. Good success with relaxation breathing technique and alprazolam 0.5mg. Continues to be wary with regard to hypnotherapy but states is happy to trial it.

Hypnotherapy session - introduction

Tim induced into hypnotic state using Staircase Method after failed attempt with Standard Relaxation Method II.

Deep hypnotic state achieved within initial 5 minutes.

Tim able to recall snow mobile trip and gave specific details using visualization technique. Described layout of accommodation and details regarding actions before the snowmobile accident.

States he had spent approximately one hour snowboarding during the morning before deciding to borrow snowmobiles and journey to the back country around Ben's grandparents property. Tim states it had been his idea to go snowmobiling and that Ben had agreed. They had borrowed the snowmobiles from a neighbor when Ben's grandparents had gone into town for supplies.

He talked through how they had chased each other through a wooded area and described how he had found his friend unconscious on the ground immediately after the accident.

At this point, I asked Tim to describe, very specifically, the events up to the point where he went to get help.

Transcript:

_"...I came around the the side of the tree and saw him lying in the snow. He was unconscious and was lying kinda at a funny angle. I killed the engine on my snowmobile and ran to his side and was yelling his name and telling him to open his eyes. I shook him by the shoulder and his head just kind of just rolled to the side. I rolled his head back up and it just rolled straight back again. I felt for a pulse in his neck but didn't really know where to feel. Then I noticed his whole body was shaking - not a lot, but his legs and arms were definitely shaking. He was making a sort of snorting sound when he breathed so I rolled him on his side and tilted his head back again. I panicked. I rolled him on his side without even thinking about spinal injury. I didn't even think about it until I had already done it. I rolled him and tilted his head back so he could breathe easier...and his arms and legs stopped shaking. There was no-one around and I knew I had to get help, so I checked he was still breathing, jumped back on my snowmobile and raced back up to Ben's grandparents place. They weren't back so I ran to the neighbors house and was screaming at them to help. While Mrs Jacobson called an ambulance, Mr Jacobson got on he back of the snowmobile and I took him back to where Ben was. He was still unconscious but was still breathing. Mr Jacobson took off his jacket and lay it over Ben to keep him warm and we sat with him until the ambulance arrived. They asked me if I had moved him and I said I just turned him on his side. I didn't tell them I'd rolled his head. I knew I should, but I didn't want to get in more trouble. _

**_[What happened then?]_**

_The paramedics fitted him with a spinal collar and strapped him to a stretcher and got him stable for transport. We waited for the medical helicopter to arrive and, just as they landed, Ben's grandparent's arrived home. His grandmother was screaming and his grandfather was having to hold her back. The police arrived and took Ben's grandparents to the hospital and another car took me to the station to give a statement. They asked me all the same questions. What were we doing before the accident. Had we been drinking or taking drugs. Did I move him. I had to sit at the station for hours answering questions and waiting for my parents to arrive. The police officers were nice enough. They gave me something to eat and drink and kept asking me if I was alright, but they kept saying I couldn't go to the hospital and that I had to wait for my parents. They wouldn't tell me how Ben was - they wouldn't even tell me if he was still alive. They just kept telling me to wait for my parents. My Mom never came. She stayed at home with my little brother. My Dad came though. He came into the interview room and just stood and looked at me for ages. The police officers left the two of us alone and I remember thinking I just wish they would stay. My Dad just kept looking at me. He blamed me - I could see it in his eyes that he thought I'd screwed up again. Only this time I'd nearly killed someone. I'd nearly killed Ben. It took him ages to say anything, but I'll never forget it. He said 'Tim, what have you done. What the hell have you done'._

[Tim started to become very emotional at this point. Used staircase method to lighten the hypnotic state momentarily before going deeper again].

_That was all he said to me. He turned around and walked out again. He signed the forms and the officers said I was free to go and they would be in touch if they needed any more information. I really wanted to go to the hospital but Dad wouldn't let me and he drove me all the way back to the city without saying a word. I always knew my father didn't love me, but that was the first time I actually realized that he didn't even really like me. I was nothing but a massive disappointment._

**_[When did you get to see Ben after the accident?]_**

_They transferred him back to New York once he was stable and my Mom took me to see him a few days later. She dropped me off at the hospital on her way to work and I went to see him by myself. My parents could barely look at me and, to be honest, I could hardly look at myself. Ben's parents met me at the hospital and his Mom pulled me into a hug and thanked me for saving his life. They didn't blame me at all. If I hadn't moved his head around, he might have been alright - his legs had been moving before I did that. And they thought I'd saved his life._

_[Tim became emotional again but able to continue without intervention]. _**_[How did you feel when you saw Ben in hospital?]_**

_He had been into surgery again the day before and was still sedated so I couldn't talk to him or anything. He was just lying there in bed and was covered in tubes and monitors. I felt sick. I wished I could go back in time and change everything. And part of me wished it had been me instead of him. Ben had so much potential and his parents had been so proud of him. I kept thinking that, if it had have been me...maybe it wouldn't have been so bad for everyone. I know it would have impacted my family, but we were never a close unit - not like Ben's - and I figured they would move on a lot easier than his family would. Instead, he was confined to hospital and rehab wards and I went off to college like everything was normal. _

**_[Did you keep in contact with Ben's family after that?]_**

_Yeah. I went to college and started pre-med. I chose Columbia because of its strong medical focus and research departments. My plan was to switch to a biology degree and to become a neuro-scientist and specialize in spinal injury. It was the least I could do for him. It was my fault he was stuck in that life and it became my mission to find a cure for paralysis. I was obsessed with it. I was getting involved with research programs at Columbia in my freshman year just to get a foot in the door for later on in my career. Most weekends I would go to the hospital and spend time with Ben. His Mom always encouraged me to keep in contact and was always real nice to me. His Dad was a lawyer and would get me to talk him through anything new in the research arena. They were more supportive than my own parents. My Mom and Dad were happy to send me off to college - particularly when I said I wanted to go to Columbia but never spoke about what happened to Ben. Needless to say, I never went on any more trips. _

**_[How long after the accident did Ben pass away?]_**

_2 and a half years. The accident happened half way through our senior year and he died at the end of my second year at Columbia. I had just finished my exams and was enrolled in a Summer research program. He had been in hospital for 9 months and then had been in a rehab centre. His family home wasn't able to be set up for his needs so his parents had bought a small unit and had it fitted out. He'd been living there with a full time team of carers for almost 9 months when he had to go back into hospital for more surgery to re-stabilize his vertebrae. The surgery was a success but he developed pneumonia and became really unwell very quickly and, with his chronically compromised immune system, he died before the antibiotics could get on top of the infection. It was a horrible time. Even though he had been so sick for so long, nobody thought he would go like that. His parents were devastated. They had two daughters, but Ben was their only son. The accident had devastated their lives. _

**_[What impact did Ben's death have on you?]_**

_My life ended as well. Ben had been the only real friend I had ever had. I could talk to him about anything. We'd laugh and joke around all the time - life was always good when he was around. He was one of those people that you just knew would be your friend forever. We would go to college, get jobs, get married, have kids but we'd always be best friends. Even though the accident had changed our friendship and changed our future, he was still my best friend. When he died, it was like I was back to being completely alone in the world. Nothing was important to me anymore. There was no point in continuing with my degree - the only reason I had wanted to do neuroscience was so I could help Ben. I got through his funeral, then went home for a few days. I was supposed to start the research program the following week but realized I couldn't live that life anymore. I needed to get out - out of college and out of the city. I couldn't cope with seeing his parents anymore - they were self destructing as well. I heard that their marriage broke down and that one of their daughters dropped out of school and got involved with drugs not long after. Their whole family disintegrated and it was all a result of the stupid accident. One mistake and I had ruined an entire family and killed my best friend. I've had to live with that every day since and I knew as long as I was in New York I would never be able to move on with my life. So, I dropped out of college. My parents were furious and threatened to disown me, but I had to go. I knew they were going to cut me off financially, so I withdrew as much as I could from the bank before that happened, bought a second hand motorcycle and left. _

**_[Where did you go?]_**

_Everywhere. I rode until I got tired and, if I liked the place, I would pick up casual work where ever I could and hang around until I was ready to move on then start all over again. I did that for a little over a year until I ended up in Florida. I'd had good memories from a couple of trips Ben and I had taken to St Pete to stay with his uncle so I thought I'd drop in on him and see how their family was going. I ended up staying there for 8 months. Uncle Michael was a great man. He took me in, gave me some home truths and gave me some direction in life. If it hadn't been for him...I really have no idea what would have happened to me. But I know it wouldn't have been good. _

**_[And are you still happy in Florida?]_**

_It's my home. I can't picture myself anywhere else. I don't want to be anywhere else. _

**_[And your family?]_**

_My family are all here. Not my biological family - but my spiritual family. For the first time in my life, I have more than one person as a true friend. I have people who care about me and who I would do anything for. _

**_[How long has it been since you've spoken to your parents?]_**

_A couple of years. Alexx got me to call a couple of years ago when I came off my bike. I don't think she really _

Tim was brought out of the hypnotic state easily using the backward count method and remained aware of our conversation.

On termination of the hypnotherapy session, Tim stated he felt 'weird' and described the sensation of being able to hear himself talking and remembering events he thought were long forgotten, but feeling relaxed and in control throughout. He stated that he feels rested and as if he had just woken from a good nights sleep.

Tim moved, as if uncomfortable, however states was simply feeling 'a little strange' talking about such personal information and feelings. States he is not someone who usually talks about his feelings and obviously very unaccustomed to sharing personal information with anyone.

Talked about why he believed he was personally responsible for Ben's accident. Tim stated it had been his idea to go snowmobiling and, therefore, he felt it was his fault that Ben was paralysed. Talked through irrational versus rational thinking and reinforced that Tim's decision making on the day were made with a 'teenage' brain and the outcome was to have fun - not to cause damage to anyone or anything. Reinforce the notion that accidents are not planned and that, as a result, no-one in this situation was logically responsible for the outcome. Tim stated that he understood it had been an accident and that the rational part of his brain knew that he had not intended for Ben to be injured, however he could not overcome the feeling that he was responsible.

Taught simple counting reinforcement technique to use until next session.

Plan: Continue on current medication regime.

Tim to continue with relaxation techniques prior to sleep

Tim to practice counting reinforcement technique regularly until next consultation to deal with negative memories.

To follow up next Monday in rooms. Scheduled appointment 1430.


	8. Chapter 8

**Please take a moment to hit the review button. Even if it's just a few words...please.**

Monday, October 25, 2004

Sixth consultation with Timothy Speedle.

Tim attended scheduled appointment in private consulting suites today. He looked physically well - clean shaven and left shoulder and states he has been sleeping better since he returned home. Tim states he has continued taking alprazolam prior to going to bed but is hoping to wean off in the near future. He states the initial side effects from when originally initiated on sertraline have abated and feeling 'OK'. States he has been 'thinking a lot' about the memories which were reawakened from our last session regarding Ben's accident and subsequent death. States has tried to combat these memories by attempting relaxation techniques however states he thinks it 'was easier to deal with when he could not remember'. Reinforced the overall goal to process these memories appropriately and to, therefore, be able to process the recent shooting events in order to function effectively in the future.

Tim has been discharged with home services and outpatient physical therapy. He states that he is also receiving and lot of support from his friends with regard to meals and company. According to Tim, Dr Alexx Woods has been staying overnight at his apartment since he was discharged and that his friend, Eric, had been 'rostered on for later in the week'. He states he is happy to accept this as 'doesn't feel up to being alone at the moment'.

On further questioning, Tim talks about feelings of vulnerability given his current physical limitations and describes feelings of being overwhelmed at times with an influx of 'bad memories'. He states he appreciates waking up and knowing he is not alone in the house. When asked how long it had been since he had shared a house with someone, Tim stated it had been 8 years and that he had lived with an ex-girlfriend for almost 6 months in St Petersburg. In the demise of the relationship, Tim had moved from St Petersburg to Miami and had not had such a serious relationship since. States, in lieu of a girlfriend at the moment, tends to confide mainly in Dr Alexx Woods and her husband with regard to personal issues although also states that he has not told them anything about recent information pertaining to Ben's accident. When questioned, he talked about being hesitant to 'drag [his] past life into his present one'. Tim went on to say he felt as if he had worked hard over the past 11 years to build a new life for himself which had enabled him to distance himself completely from his childhood and to reinvent himself with new friends and a 'new family' who knew nothing of his past other than very basic information.

Discussed the importance of being able to confide in trusted individuals and talked about the physical and psychological effects of carrying such a heavy mental burden through life without support.

Tim was challenged to list several people he would feel comfortable to confide in regarding the events surrounding Ben's accident and his subsequent departure from his life in New York. He identified Drs Alexx and Joe Woods as two people he felt comfortable talking about most things with but states he did not want to 'burden' them with his past as he felt it would result in them seeing him differently and would affect their close friendship. He states he did not feel he could discuss matters of such a personal nature with his best friend, Eric Delko, nor his colleague Calleigh Dusquene. He states he has two close friends outside of work, Matt Harkins and Rachel Bianco, but, again, feels as if it would risk affecting the status of their current friendship.

Given the lack of solid friendships throughout Tim's childhood, I believe he struggles to understand the concept of non judgmental friendships and loyalty - despite Tim clearly exhibiting these traits among his own friends. Reinforced to Tim that confiding in trusted friends adds depth to these relationships and asked if he had ever played the role of confidant to any of his friends. He was able to identify several examples when he had been the 'trusted friend' and confirmed that the experience had not adversely effected their friendship and he still saw them as the same person they had been prior to them confiding in him. Reinforced that confiding in his trusted friends, was an important step in his recovery from both his childhood and the recent shooting.

Talked about recent studies showing significant benefits of unburdening oneself of negative experiences and the impact of talking to others in overall healing and psychological progression through to wellness. Highlighted the reduction in depression rates and anxiety through sharing experiences and reinforced that, despite the difficulty in opening up to others, the benefits are often profound.

Asked Tim to nominate one person he trusted completely to share the experience of Ben's death with. He identified Lieutenant Caine and states that, although he expects it to be very difficult to tell him, he feels he is the one person who would listen and not pity him. When questioned about his friendship with Lt. Caine, Tim states he has been his boss on and off for his entire time in Miami and that he had been the one to hire him from St Petersburg. He talked about how he had always seen Lt. Caine as someone to look up to and how he admired him as a person as well as a boss and mentor. On further discussion, it is apparent that Tim has substituted Lt. Caine as his father figure in the absence of his biological father in his life. He is driven in his need for acceptance and to be respected by him. Based on my discussion with Lieutenant Caine, I believe that the feeling is reciprocated with him seeing Tim as a surrogate son and, as such, I have reinforced him as a good candidate as a confidant. Reinforced complete confidentiality of these sessions.

PLAN: I have received permission from Tim to contact Lieutenant Caine again and to set up a time of mutual convenience to help him talk through the events of Ben's accident and death.

Tim to continue relaxation techniques (breathing techniques prior to sleep and counting techniques in times of increased anxiety or when heavily burdened from previously repressed traumatic memories).

Scheduled next appointment for Friday, October 29 - to continue with normal appointment if unavailable to attend.

**Again, please hit the review button. Thanks in advance. **


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